Natriuretic peptide B plasma concentration increases in the first 12 h of pulmonary edema recovery.

BACKGROUND: According to guidelines, single determination of B-type Natriuretic peptide (BNP) should be used for distinguishing between cardiac and non-cardiac acute dyspnea at the emergency room. BNP measurement is also recommended before hospital discharge in patients hospitalized for heart failure to assess prognosis and to evaluate treatment efficacy. In acute cardiogenic pulmonary edema, BNP is measured using a single BNP determination, but the temporal behavior of BNP during pulmonary edema recovery is unknown. METHODS: Fifty chronic low ejection fraction (<40%) heart failure patients (age 77 ±â€¯9 years, 17 M-33F) admitted for acute pulmonary edema were studied. Patients were grouped according to 50% dyspnea recovery time into 3 groups: ≤30 min (n = 14), 30 to 60 min (n = 19), and > 60 min (n = 17). BNP was measured at arrival and 4, 8, 12 and 24 h afterwards. RESULTS: At arrival, BNP was elevated in all patients without significant difference among groups. In the entire population, BNP median and interquartile range value were 791 (528-1327) pg/ml, 785(559-1299) pg/ml, 1014(761-1573) pg/ml, 1049(784-1412) pg/ml, 805(497-1271) pg/ml at arrival and 4, 8, 12 and 24 h afterwards, respectively, showing higher values at 8 and 12 h. This peculiar temporal behavior of BNP was shared by all study groups. Patients with the longest edema resolution showed the highest BNP level 8 and 12 h after admission. CONCLUSIONS: In acute pulmonary edema, BNP increased up to 12 h after emergency admission regardless of dyspnea recovery time, making BNP quantitative meaning in the acute phase of pulmonary edema uncertain.

Left mitral isthmus ablation associated with PV Isolation: long-term results of a prospective randomized study.

BACKGROUND: The deployment of an ablation line connecting the left inferior PV to the mitral annulus (mitral isthmus line [MIL]) enhances the efficacy of pulmonary vein disconnection (PVD) in preventing atrial fibrillation (AF) recurrences. OBJECTIVES: To investigate the long-term effect of the additional linear lesion in a prospective randomized study. METHODS: One hundred and eighty-seven patients (37 females, mean age: 55 +/- 11 years) with paroxysmal (126) or persistent (61 patients) AF, were prospectively randomized into two groups: PVD (group A, 92 patients) or PVD combined with MIL (group B, 95 patients), performed by means of an irrigated-tip ablation catheter. RESULTS: Successful disconnection of all PVs was achieved in all patients. A bidirectional block (BB) along the left atrial isthmus was obtained in 72 of 95 (76%) patients in group B, most of whom required additional RF pulses from within the distal CS. A transient ischemic attack occurred in 1 patient of group A, and a cardiac tamponade occurred in 1 patient of group B. At 1 year, 53 +/- 5% (group A) and 71 +/- 5% (group B) remained arrhythmia free (P = 0.01); subgroup analysis highlights a higher improvement among patients with persistent AF (74 +/- 9% vs 36 +/- 9%; P < 0.01) than what was observed in paroxysmal AF (76 +/- 6% vs 62 +/- 6%; P < 0.05); antiarrhythmic drugs were continued in 56% and 50%, respectively, in groups A and B (P = ns). CONCLUSIONS: The addition of mitral isthmus line to the PV disconnection allows a significant improvement of sinus rhythm maintenance rate, particularly in patients with persistent AF, without the risk for major complications.